Extended matching questions: how to approach them
An extended matching question gives you one list of options and several short scenarios. You match each scenario to its best option. This guide gives a method, then a practice set to try it on.
Not affiliated with the General Pharmaceutical Council. This guide is for revision only. It is not clinical or legal advice, and its worked examples use invented numbers. Check a current source before you rely on any point.
How the format works
An extended matching question (EMQ) has three parts: a theme, a list of lettered options, and a set of scenarios, each with its own question. Read the instruction line each time. In this style the same option can usually be the best answer to more than one scenario, and some options may not be the answer to any. Never assume the options are used once each.
The format tests whether you can tell similar things apart. A list of all the drug classes that cause a problem is only useful if you can choose the right one for a particular patient.
A five-step method
- Read the option list first. It tells you what the theme is, before the first scenario pulls you in a different direction.
- Take each scenario separately. Do not try to match all of them at once. Cover the options, read the scenario, and decide what the answer should be.
- Look for the deciding detail. Most scenarios carry one fact that fixes the answer: a kidney function, a route, an age, a time frame.
- Then check the options. Find your answer in the list. If two options fit, go back to the deciding detail.
- Mark and move on. If you are stuck, choose the best match and flag it. Set yourself a time cap per scenario in practice, and stick to it. Return to flagged ones if you have time.
Three traps
- The reused option. Having used option A once, you may avoid it for the next scenario. Do not. Use it again if it fits.
- The nearly right option. Options are often related, such as two risks of the same medicine. Ask which one the scenario actually points to.
- Answering the clinical story, not the question. The scenario may mention many details. The question line says what to choose.
Practice set: sick day rules
These are our own questions. Try them before you read the reasoning. The answers follow the NICE CKS advice for adults with type 2 diabetes.
Theme: the main risk behind the sick day advice for each medicine during an acute illness.
A Acute kidney injury
B Euglycaemic diabetic ketoacidosis
C Hypoglycaemia
D Lactic acidosis
E Angioedema
F Pancreatitis
For each patient, choose the option that is the main reason for the advice. Each option may be used once, more than once or not at all.
- A 68-year-old man with diarrhoea is taking ramipril and bendroflumethiazide.
- A 55-year-old woman with vomiting is taking metformin.
- A 47-year-old man is acutely unwell with a chest infection and is not drinking. He takes dapagliflozin.
- A 72-year-old woman is eating very little with a stomach bug. She takes gliclazide.
- A 60-year-old man at risk of dehydration takes a GLP-1 receptor agonist.
Answers and reasoning
- A, acute kidney injury. An ACE inhibitor and a diuretic are both on the stop list when there is a risk of dehydration, to reduce the risk of AKI. The deciding detail is that there are two drugs from the AKI group.
- D, lactic acidosis. Metformin is stopped when there is a risk of dehydration, to reduce the risk of lactic acidosis.
- B, euglycaemic diabetic ketoacidosis. An SGLT-2 inhibitor: check ketones and stop if acutely unwell or at risk of dehydration. The deciding detail is "acutely unwell", not the dehydration alone.
- C, hypoglycaemia. A sulfonylurea may increase the risk of hypoglycaemia if dietary intake is reduced. The deciding detail is that she is eating very little. This one is not about dehydration.
- A, acute kidney injury. A GLP-1 receptor agonist is stopped if there is a risk of dehydration, to reduce the risk of AKI. A was used for question 1 as well, and here it is used again.
Look at the pattern in your own answers. If you chose B for question 1 because you linked dehydration with ketoacidosis, the fix is to learn the reason for each medicine, not the list. The sick day rules guide sets those reasons out.
Build your own
For any topic, write the option list from your notes (all the monitoring tests, all the interactions of one drug, all the reasons for a referral). Then write four scenarios, each with a single deciding detail. Swap them with a friend if you have one. Writing the scenarios teaches the details better than reading answers.
When you get an EMQ scenario wrong, write down the deciding detail you missed. Ten of those make a better revision list than a topic outline.
Sources
- NICE CKS: Diabetes - type 2, management (managing intercurrent illness; sick-day rules). https://cks.nice.org.uk/topics/diabetes-type-2/management/management-adults/. Accessed 22 October 2026.
Not affiliated with the General Pharmaceutical Council. Revision only, not clinical or legal advice. Worked examples use invented numbers and products. Every source above was read on 22 October 2026; check anything that matters against a current source. See our terms of use and privacy notice.